Medicare Plans Wyoming

Coverage and Benefits

Do you live in Wyoming? Are you getting ready to turn 65 years of age? If so, then you should be preparing yourself to enroll in the federal Medicare program. Together, Medicare Parts A and B make up the base plan. Part A covers your hospital needs, such as visits and treatment, and Part B covers your outpatient healthcare, such as doctor visits and non-hospital procedures.

Although the Medicare program is designed to be as affordable as possible, there are some basic costs associated with enrollment. Part B starts out with a yearly deductible and required monthly premiums for every single enrollee. If you would like to estimate those potential costs, you can research the numbers on this page. Fortunately, Part A can be free, but it depends largely on your employment history. Anything less than 10 years (or 40 cumulative quarters), though, and you will have to pay a deductible for Part A.

Medicare Part A (Hospital Coverage)

Inpatient care in hospitals

Skilled nursing facility care

Hospice care

Home health care

Medicare Part B (Medical Insurance)

Services from doctors and health providers

Outpatient care

Home health care

Durable medical equipment

Some preventive services

Medicare Part C (Medicare Advantage)

Includes all benefits and services covered under Part A and Part B

Usually includes Medicare prescription drug coverage (Part D) as part of the plan

Run by Medicare-approved private insurance companies

May include extra benefits and services for an extra cost

Medicare Part D (Drug Coverage)

Helps cover the cost of prescription drugs

Run by Medicare-approved private insurance companies

May help lower your prescription drug costs and help protect against higher costs in the future

Supplementing Medicare Plans in Wyoming

Wyoming has a modest population of only 84,076 residents which are currently enrolled in the federal Medicare program. Of those, the smallest minority have chosen to supplement their Medicare benefits with a Medicare Advantage policy: 3%, or 2,522 individuals. A significantly larger chunk of beneficiaries – 36%, or 29,997 people – are supplementing their Medicare coverage gaps with a Medigap supplement. And the largest percentage, 61%, represents the 51,286 Wyoming seniors who either have some additional form of supplementation, such as that offered through an employer, or absolutely no Medicare supplementation at all.

Don’t forget to enroll in Medicare first before looking into purchasing supplemental coverage. Learn everything you need to know about Medicare enrollment by clicking that link.

How Important Are Medicare Supplement Policies?

Depending on your circumstances, they can be essential to managing your health care needs at the most affordable cost. If something unfortunate were to happen, such as an extended hospital stay or months of rehab from a physical injury, you might be required to pay some hefty out-of-pocket prices which Traditional Medicare won’t cover. Such as:

Medicare Part A Costs

Medicare Part B Costs

$1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services

For many, especially those who are well into their golden years and living on a fixed income, leaving their health care coverage to chance is a gamble they cannot afford to make. Obtaining supplemental health insurance helps protect them from the gaps in Medicare, and eases their worries. There are two main options for supplementing Medicare which we will get into presently: Medicare Advantage, and Medigap.

Choosing Medicare Supplement Coverage

Medicare Supplement Coverage, commonly referred to as “Medigap” policies, give you health care coverage where Medicare Parts A and B do not. The 10 federally approved and regulated plans are included in the chart below, and include plans A, B, C, D, F, G, K, L, M, and N. Up until 2010, plans E, H, I, and J also existed, but the Medicare Modernization Act eliminated them from the available choices. The good thing about the way these Medigap policies are structured is that they are the same in every state, through every insurance provider. The only thing that varies across state lines is the price of the policy.

Below are the benefits that every Wyoming resident can expect from their chosen Medigap policy:

Plans

A

B

C

D

F

G

K

L

M

N

Part A Hospital Coinsurance

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

Hospital Reserve Days

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

Benefit For Blood

✓

✓

✓

✓

✓

✓

50%

75%

✓

✓

Part B Coinsurance

✓

✓

✓

✓

✓

✓

50%

75%

✓

*Co-Pays

Hospice Coinsurance

✓

✓

✓

✓

✓

✓

50%

75%

✓

✓

Skilled Nursing Facility

✖

✖

✓

✓

✓

✓

50%

75%

✓

✓

Part A Deductible

✖

✓

✓

✓

✓

✓

50%

75%

50%

✓

Part B Deductible

✖

✖

✓

✖

✓

✖

✖

✖

✖

✖

Part B Excess Charges

✖

✖

✖

✖

✓

✓

✖

✖

✖

✖

Foreign Travel Benefit

✖

✖

✓

✓

✓

✓

✖

✓

✓

✓

Preventive Care Coinsurance

✓

✓

✓

✓

✓

✓

✓

✓

✓

✓

Out of Pocket Limit

None

None

None

None

None

None

$4,620

$2,310

None

None

Co-Pays are $20 per office visit, and $50 per ER visit if not admitted to a hospital.** A checkmark indicates 100% coverage for the specified benefit.

Option #2: What is Medicare Advantage?

Medicare Advantage, Medicare Part C, and ‘Medicare Replacement Policy’ all refer to the exact same thing. Medicare Advantage (or MA for short) is essentially a private Medicare replacement. Instead of getting your claims paid out by Uncle Sam, a private insurer will take over those duties. Legally, though, you will not be losing any Medicare benefits. MA plans have to provide you with the same minimum coverage that you would receive from Traditional Medicare. That is the law.

However, as long as you are getting the bare minimum Medicare benefits, your MA provider can also throw in extras, like vision or prescription drug coverage, in order to sweeten the deal. Many companies do exactly that. Of course, premiums and additional costs will rise to help pay for the extra coverage. In order to balance things out and keep costs low, many MA providers prefer to keep their networks limited. So it’s a tradeoff – you may have access to better coverage at an affordable price with MA, but you may end up having to switch doctors.

The specific networks through which Medicare Advantage plans usually operate are referred to as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs).

Top HMO Plans in the Area

Cost

Plan Name

Coverage Type

Premium

Deductible

Rating

$0

VIVA Medicare Plus (HMO)

Health and Drug

$0.00

$125

$0

VIVA Medicare Select (HMO)

Health Only

$0.00

$0

$0

Cigna-HealthSpring Preferred (HMO)

Health and Drug

$0.00

$0

Top PPO Plans in the Area

Cost

Plan Name

Coverage Type

Premium

Deductible

Rating

$0

HumanaChoice R5826-065 (Regional PPO)

Health Only

$0.00

$0

$828

HumanaChoice R5826-001 (Regional PPO)

Health and Drug

$69.00

$40

The Real Differences between Medicare Advantage and Medigap

It can be difficult to determine which supplemental policy will meet your medical care needs at a cost that won’t ruin your budget. Take a look at the table below. It will help explain some of the key differences between each plan, as well as give you an idea of what you might be expected to pay for vs. what should be covered.

Questions

Medicare Advantage

Medicare Supplement

How are the plans funded?

Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.

Your monthly premium takes care of the majority of your expenses.

Do I continue paying for Part B?

Yes

Yes

What does it cost me?

Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.

While each plan does require a monthly premium, many of them are affordably priced.

What does the plan cover?

Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.

All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.

Can I budget my health care expenses?

It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.

Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.

Can my plan be cancelled?

Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.

No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.

Are pre-approvals or pre-certifications required?

Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.

No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.

Can I use any doctor or hospital?

Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.

Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.

Can drug, vision, or dental coverage be included in the policy?

Yes.

No. These forms of coverage must be purchased separately.

Who is this plan type generally best suited for?

If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.

If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

Informative Medicare Resources

This article is a broad analysis of Medicare supplemental coverage, and contains just enough helpful information to get you started. From here, you can take it the rest of the way by doing some investigation on your own. Below are links and contact information of various offices which specialize in Medicare. Talking to any of these experts can definitely help you start going down the right path.

Important Medicare Terms

HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.

PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.

Co-Pay: Amount of money charged per visit to doctor, specialist, etc.

Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.

Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.